CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2015 ending 12/31/2015 Date of Report:02/13/2016 Page: 1
List order: No List
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 668 319.250000 11779.5000 36.8974
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 760 691.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2134 6304.000000 226469.5000 35.9247
Subtotal (Total Children Is Unduplicated) 2172 7315.000000 238249.0000 32.5699
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 31 75.000000 3750.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 7.000000 525.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 9 13.500000 1012.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 4.500000 337.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 11 17.500000 1312.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 7.000000 387.5000 55.3571
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 34 51.000000 3629.2500 71.1618
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 41 57.000000 4275.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 25 39.500000 2962.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 34 54.500000 2941.5000 53.9725
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 27 40.500000 3037.5000 75.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 181 370.000000 24321.3500 65.7334
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 1070.0000 1070.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 34 44.000000 1750.0000 39.7727
CONIF-CONIF-CONSULT, FACE TO FACE 37 55.500000 2350.0000 42.3423
CONIP-CONIP-CONSULT, PHONE 1 4.000000 25.0000 6.2500
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 122 385.500000 15355.0000 39.8314
INTR-T1013-INTERPRETER 6 78.000000 1050.0000 13.4615
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 664 2227.000000 22043.9200 9.8985
OCCT-97530-OT SESSION BY LICENSED OT 26 101.500000 4976.8800 49.0333
OCCT-97530HM-OT SESSION BY OT ASST 1 1.000000 57.2000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 33 111.500000 7820.7100 70.1409
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 47 238.500000 13122.9000 55.0226
SPL-92508-GROUP SPL SESSION PER CHILD 8 235.000000 3261.8000 13.8800
TRAV-TRAVS-Travel by mile 49 1447.000000 643.7700 0.4449
Subtotal (Total Children Is Unduplicated) 751 4931.500000 73563.1800 14.9170
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Total 12616.500000 336133.5300 26.6424
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Number of Children (Unduplicated) With at Least One Service 2227
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Center 01
Flag Claims Units Chgs Paid
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R 8 3.000000 118.4400 0.0000
U 0 0.000000 0.0000 0.0000
B 6411 4320.750000 165477.6200 0.0000
P 40 88.000000 1134.9800 1134.9800
D 4 4.250000 219.2500 0.0000
S 289 272.500000 10058.3400 0.0000
H 28 39.500000 2930.3800 0.0000
T 117 148.000000 2427.1800 2307.1800
4765 3084.750000 83582.8400 0.0000
Other 2918 4655.750000 70184.5000 0.0000
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Total 14580 12616.500000 336133.5300 3442.1600